Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Tuesday, April 17, 2007

I hesitate to even write this post but to the extent that I can bring a bit of a medical perspective to the massacre in Blacksburg then maybe I can be forgiven.

First. As someone who works very closely with EMS and less so with the police, and as someone who knows a whole lot about Columbine (for reasons I can not explain here) please let me implore you to dismiss those who seek to throw blame on the police or the emergency system out of hand. In emergency situations and emergency medicine in particular (both pre-hospital and in-hospital) we train for stuff like this, but since school shootings, believe it or not, are still vanishingly rare, our time is better spent training for major motor vehicle crashes or natural disasters or even a chemical weapons attack. As far as I know the response of the police, paramedics, nurses, and physicians yesterday was above and beyond excellent.

Second. I have met people, and sometimes I meet more than one on a single day, who consider their lives forfeit. Usually these people simply wish to kill themselves, but sometimes they want to kill others. Simple fact, if I'm interviewing them then they have a shred of humanity left and have a chance to recover. We are so conservative about this on the medicine side that usually the mere mention of suicide or homicide buys you an involuntary 72-hour stay at an inpatient psychiatric facility. However, once you don't care whether you live or die and you decide to keep it secret then there is precious little that anyone can do to stop you in whatever it is that you are planning.

Whether it is tossing yourself from a hotel balcony with the television cameras rolling and writing your last "fuck you world" all over the pavement in your own blood, whether it is driving a truck full of homemade high-explosive to a populated downtown intersection to blow it up, whether it is planning for years to hijack a plane full of jet-fuel and crash it into the World Trade Center, or whether it is sneaking a couple of semi-automatic pistols onto your college campus and executing your classmates, you will probably succeed in transferring your pain to others. Pure black emptiness.

In my personal experience I learned this from a patient that I spent 10 hours with as he recovered from an "unintentional" opiate overdose. He managed to convince me, his wife, and the psychiatrist that he was simply trying to sleep and that there was no need to hospitalize him. We eventually discharged him and he killed himself that night.

I guess it comes down to this; if you believe that we make choices and have free will (even if it is affected by genetics and environment) then blame the shooter, if you believe that we are 'programmed' (either by genetics or our environment or both) then go look for someone else to blame, and realize as you do, that if we are merely 'programmed', then blame, any kind of blame, makes no sense.

9 comments:

Well said, You put into words what I've been thinking but unable to verbalize.

I knew and worked with the flight crews on 2 of the 9/11 planes. A pilot friend of mine lost a child and had a nephew/niece injured during Columbine.

Unfortunately we've learned very little since 9/11.

When events like this happen the natural and easy target are police officers, firefighters, EMS personnel and the doctors and nurses who were unable to save the victims. Their response times or response to injuries are always called into question.

All in all I'd say for an all student volunteer EMS system on campus (EMT B's and Paramedics), I think they did a fantastic job. Considering their likely age, experience and relationship to the victims they deserve more than blame and pointing fingers. They deserve to be honored as the heroes they are.

As one kid said his buddy in Iraq called to check on his wellbeing and commented on the irony of their situations.

I think (hope?), the mediblogs will eventually help people to come to an understanding of the truth of things.

Ok it's late, I'm rambling and my head is spinning from arteries vs veins and the path of a blood cell through the circulatory system.

I feel sadness for anyone involved in this in any way. The victim's families are suffering, and I am sure the shooter's family is suffering just as much (if not more because people are angry and so full of hate for their son). I find it so sad that people sometimes feel so lost that things like this have to happen. Such a tragedy for everyone involved. I just can't imagine what it would feel like to feel so hopeless that this felt like your only choice.

It truly was a tragedy that happened at Virginia Tech. What struck me most about your post, though, was the part on determination- if someone truly doesn't care, it's frightening what can be accomplished. It makes me wonder- I go to a primarily engineering school and work on the campus volunteer ambulance, made of primarily EMT B's and attendents in training. I know if we were forced to deal with a similar situation, our performance would be shaky at best. We are primarily students, new to CPR, stretchers, and bullet wounds. We deal with drunk students, hurt atheletes, lightheaded professors- to criticize a volunteer squad of students trying to hold themselves together while saving classmates- I can't really think of a more heartless criticism.The shooter was the one who pulled the trigger, the EMTs were the ones trying to keep their friends out of body bags.

Thanks for all of your posts, particularly this one. As a resident of the beautiful state of Virginia, I realize how deeply affected, not only our state is, but the entire country by this unfathomable act of selfishness and cruelty.

Virginia thrives on its rich history and the contributions made to this wonderful country we are are so privileged to live in. Now, one of the most respected and appreciated landmarks of Virginia has been scarred forever.

I work with so many people that have either attend VT or have children there. There is a gentleman in my office, who's son was able to escape to safety through a window of Norris hall during that horrible ordeal. We are all so thankful for his safety but feel so empty for those that were lost.

Regardless of what schools we've attended or what mascot's we always root for, I think for awhile we are all going to be Hokies.

I wasn't aware anyone was blaming the EMS or police for any problems with their responses. I've seen some blame cast toward the e-mail alert sent by the school and toward the lack of involuntary psychiatric commitment despite the warning signs the shooter displayed. Neither of those are justified imo.

It's not easy to involuntarily commit someone to a psych facility, however, for many good reasons. Such treatment doesn't always prevent tragedies anyway (see Andrea Yates, for one example).

As for the EMS/ER responses, it's hard enough to manage one or two penetrating traumas at a time. Half a dozen at once even in a major trauma facility can be a real challenge. I can't imagine the scene that local ER had to deal with.

scalpel, you are correct. i have heard lots of grousing about the police and the pre-massacre psychiatric situation but nothing about EMS or docs/nurses. i believed, when it happened, that this would be a given and that it wouldn't be long before the blame net was cast far and wide. people so want to make sense of it and blame follows.

taking care of a patient right now in my ER who was sent from school because he and a friend were going to shoot themselves in the cafeteria. i placed him on a hold. the mom, wearing a Va Tech lapel ribbon, is now being escorted off our property by police and the child is being restrained chemically and physically. the mom is threatening law suits and calls to our senator etc... i don't even know what to think about her but she, evidently, one who can not look in the mirror.